GI

Question 1

Crohn’s

Induce and maintain remission

Answer 1

Inducing remission:
Stop smoking, elemental diet
1) Glucocorticoids - oral budenoside (mild) prednisolone (moderate), IV hydrocortisone (severe)

Maintaining remission:
Azathioprine (immunosuppressant)

Question 2

Ulcerative Colitis

Mild and Severe

Answer 2

1) Aminosalicylates - mesalazine
2) Oral prednisolone

If severe:

1) IV corticosteroid (hydrocortisone)
2) IV ciclosporin

Question 3

GORD

Answer 3

1) Lifestyle changes (Weight loss, Smoking stop, dietary (smaller meals, reduced coffee alcohol and spicy foods)
2) PPI - Omeprazole (H+/K+ ATPase inhibitor in parietal cells)
3) H2 receptor antagonist - Rantidine (histamine 2 receptor antagonist)

Question 4

Coeliac

Answer 4

Gluten free diet

Dietary supplements

Question 5

Irritable Bowel Syndrome

6 examples of lifestyle advice + pharmacological

Answer 5

Lifestyle advice:
- Adequate fluid intake
- Low FODMAP diet
- Reduce Stress
- Small, regular meals
- Limit caffeine and alcohol
- Weight loss if obese or overweight
- Fibre if constipated, cut fibre if diarrhoea
Pharmacological:
1) Antidiarrhoeal - Loperamide 
2) Laxative - Lubiprostone (avoid lactulose - bloating) 
3) Antidepressant - amitriptyline

Question 6

Gastritis

Answer 6

• Remove causative agents (alcohol/NSAID)
• H2 antagonist - Ranitidine (reduce acid release)
• PPI - omeprazole (Inhibit H+/K+ ATPase in parietal cell)
• Antacid
• Clarithromycin, amoxicillin if H Pylori+
  (Metronidazole if penicillin allergic)

Question 7

Peptic ulcer disease

With and without bleeding

Answer 7

1) If bleeding, IV crystalloid fluids.
- Upper GI endoscopy with mechanical therapy e.g. clipping + adrenaline
- Surgery or embolisation

2) If no bleeding, Treat/reduce risk factors.
- H. Pylori negative - High dose PPI (omeprazole)
- H. Pylori positive - triple eradication therapy (omeprazole, clarithromycin, amoxicillin [metronidazole if penicillin allergic])

Question 8

Varices

gastric/oesophageal

Answer 8

IF BLEEDING: Terlipressin IV

Oesophageal - Endoscopic variceal band ligation
Gastric - Endoscopic sclerotherapy with N-butyl-2-cyanoacrylate

Transjugular intrahepatic portosystemic shunt (TIPS): If endoscopic treatment fails.

2) Beta blocker (propanolol), long term prevention, keep portal BP low

Question 9

Appendicitis

Answer 9

Fluids, analgesia, antiemetics and preoperative antibiotics (prophylactic) - ceftriaxone

Prompt laparoscopic appendicectomy. incision below McBurney’s point

Question 10

Diverticulitis + staging

Answer 10

Antibiotics - co amoxiclav
Blood transfusion if bleeding
Angiographic embolisation

Elective colonic resection if recurrent

Question 11

Mesenteric ischaemia

Answer 11

Bowel rest (nil by mouth)
IV heparin (anticoagulation)
Broad spectrum antibiotics - Clarithromycin

Laparotomy - arterial bypass or embolectomy

Question 12

H Pylori

Answer 12

Omeprazole, clarithromycin, amoxicillin